The introduction of percutaneous osseointegration biotechnology in 1979 to head and neck reconstruction permanently revised the long held view that a facial prosthesis was a last resort for the patient and surgeon alike. Since that time, the use of extraoral osseointegration has expanded considerably. The present review of the literature considers indications and methods of care for aspects of extraoral osseointegration as it relates to facial prosthetics. The clinical literature reviewed was graded for hierarchy of strength of evidence according to the Bandolier system. Almost all literature reviewed was of the lowest level of strength of evidence. Consequently, clinicians are advised to be cautious in applying the evidence to patients.